Senior Health Benefit Plan Consulting Attorney

🔥 17 hours ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $125k - $160k / year

⏰ Full Time

🟠 Senior

🧑‍💼 Attorney / Lawyer

👻 Ghost score 0%

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The Phia Group, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2000

💼 Consulting

🏥 Healthcare

🛡️ Insurance

💰 Private Equity Round on 2018-09

Consulting • Healthcare • Insurance

The Phia Group, LLC is a dedicated provider of healthcare cost containment solutions, focusing on empowering self-funded health plans to maximize benefits and minimize costs. Through a comprehensive suite of services, including subrogation and recovery, claims negotiation, and cost transparency initiatives, The Phia Group aims to help employers and families navigate the complexities of healthcare with advocacy and expertise. Their commitment to improving healthcare accessibility and affordability sets them apart in the industry.

📋 Description

• Manage and support reviews of member and provider appeals, grievances, and complex claims issues, particularly in self-funded and ERISA-regulated plans • Evaluate benefit exclusions, plan document terms, and medical necessity disputes to determine appropriate claim outcomes • Coordinate with applicable vendors to ensure timely and accurate facilitation of independent clinical reviews • Review determination letters, appeal responses, and other member/provider-facing communications for legal sufficiency and regulatory compliance • Support internal audits, agency audits, corrective action plans, and external regulator or client requests • Conduct legal research on applicable law and regulations; draft consulting memoranda; provide consultative advice and analyses to the legal team • Review healthcare industry contracts • Respond to client inquiries regarding agency rules, statutory requirements, and legal compliance • Communicate with health plan administrators and other healthcare industry entities by phone, video conference, or in person • Answer questions regarding compliant health plan administration and explain applicable law or health plan terms • Draft ERISA- and ACA-compliant health plan documents, including MHPAEA required reports • Assist in resolving disputes between healthcare industry participants • Analyze health plans and related documents and summarize findings for the legal team • Perform other duties as assigned

🎯 Requirements

• Juris doctor from an accredited law school and admittance to a state bar (active) • 3-7 years of experience in the healthcare industry or in similar industries preferred (i.e., employment law, insurance law, disability law, workers’ compensation law) • Knowledge of the latest developments in health law, including a working understanding of the ACA, ERISA, MHPAEA, and HIPAA • Superior legal writing, analytical, and proofreading skills, as well as strong attention to detail • Outstanding organizational, interpersonal, and negotiation skills • Ability to work collaboratively or independently as needed, and to work sensitively with confidential matters • Ability to effectively communicate and interact with various positions throughout our organization as well as with clients • Ability to successfully manage multiple projects simultaneously • Ability to participate effectively and confidently in client phone calls, including occasional video conference calls • Ability to anticipate issues and create and implement methods for optimizing results and minimizing risks • Ability to develop a deep understanding of the business and operational goals • Comfortable working in a fast-paced environment • High level of proficiency using Microsoft Word, Excel and Outlook • Must be self-motivated and able to meet deadlines under pressure • Excellent academic credentials • Strong preference for experience working with health plans, third-party administrators, and/or health insurance carriers • Familiarity with administrative rules published by relevant federal agencies, including HHS, the DOL, and the IRS • Knowledge of CMS billing and payment rules and processes, or medical coding generally • Confidence in public speaking • Willingness to travel

🏖️ Benefits

• Unparalleled benefits for yourself • Equal opportunity employment • Reasonable accommodations as needed under the ADA